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Arteriovenous fistula as a complication of transradial coronary angiography: a case report
Dehghani Payam,Culig Jennifer,Patel Darshan,Kraushaar Greg
Journal of Medical Case Reports , 2013, DOI: 10.1186/1752-1947-7-21
Abstract: Introduction Iatrogenic arteriovenous fistula is a vascular condition that may result from coronary angiography. Many case reports have described arteriovenous fistula occurrence after coronary angiography using the transfemoral access route, but rarely as a complication of using the transradial approach. We report a rare case of a patient with arteriovenous fistula following transradial artery coronary angiography. Case presentation A 62-year-old Caucasian man underwent emergent coronary angiography using the right radial artery approach. One month after angiography, he discovered a turbulent sound near the access site. A right radial arteriovenous fistula was found upon duplex ultrasound investigation. The patient was treated conservatively. At 1-year follow-up, the arteriovenous fistula was unchanged and the patient remained hemodynamically stable and asymptomatic. Conclusion Iatrogenic arteriovenous fistula is a rare vascular complication of transradial artery coronary angiography. The natural history of arteriovenous fistula is benign and is thought to resolve spontaneously; therefore, a conservative approach, as opposed to surgical ligation, is recommended as the first-line treatment.
Performance of single reshaped Judkins left catheter for transradial coronary angiography  [PDF]
Guangming Zhang, Wei Cui, Ruiqin Xie, Fan Liu, Guoqiang Gu, Jingchao Lu, Hongmei Zheng, Xiuchun Yang, Xiaohong Yang
World Journal of Cardiovascular Diseases (WJCD) , 2013, DOI: 10.4236/wjcd.2013.39091
Abstract:

Background: To investigate the feasibility of single reshaped Judkins left catheter for transradial coronary angiography. Methods: A total of 198 consecutive patients were enrolled in the first step study. Patients were randomly assigned to brachial type catheter group (BRACT group) or Judkins left catheter group (Judkins group). The inclusion criterion was the left coronary angiography which could be accomplished by either a brachial type catheter or a reshaped Judkins left catheter. The successful procedure was defined as both right and left coronary angiography could be completed with a single reshaped Judkins left catheter or a brachial type catheter. Furthermore, 1873 consecutive patients were continuously enrolled to observe the success rate of single Judkins left catheter for transradial coronary angiography. Results: Of the 198 patients, 191 were finally enrolled in this study according to the inclusion criteria, with 95 patients in BRACT group and96 inJudkins group. There were no significant differences on baseline between the two groups. Procedure success rate was 84.10% with a fluoroscopic exposure time of 3.81 ± 0.43 min in BRA-CT group, and 81.60% with a fluoroscopic exposure time of 4.05 ± 0.48 min in Judkins group (P > 0.05). No severe complications were found in either of the two groups. The success rates of 1869 patients with single Judkins left catheter for transradial coronary angiography were 75.33%. There were no complications in those patients. Conclusions: Transradial coronary angiography with a reshaped single Judkins left catheter is feasible and practical, with an accepted procedure success rate. This method should be worthy of further clinical validation in a larger scale population.

 

Balloon-Assisted Tracking to Overcome Radial Spasm during Transradial Coronary Angiography: A Case Report  [PDF]
N. J. W. Verouden,F. Kiemeneij
Case Reports in Cardiology , 2014, DOI: 10.1155/2014/214310
Abstract: Spasm of the radial artery is the most important cause of failure to perform coronary angiography via the transradial approach. Spasmolytic cocktail may prevent radial artery spasm but is relatively contraindicated in patients with aortic stenosis or diminished left ventricular function. In this case report we describe a recently published technique to overcome severe radial spasm during transradial coronary angiography in a patient with moderate aortic valve stenosis. 1. Introduction After a two-decade evolution, the transradial approach (TRA) in coronary angiography and percutaneous coronary intervention (PCI) has become a viable and attractive alternative for the femoral approach [1–4]. The increased adoption of the TRA originates from high procedural success, reduced risk for major access site related bleeding complications, lower mortality, increased patient comfort, and cost reduction [5–7]. One of the most encountered problems is radial artery spasm. In a multicenter registry containing over 1900 transradial procedures, the incidence of radial spasm was 2.7%, with multiple puncture attempts and use of larger introducer sheaths (7F) being independent predictors of radial spasm [8]. Another prospective study reported female gender as an independent contributor to the incidence of radial spasm [9]. Furthermore, spasm can be triggered by excessive manipulation of intra-arterial wires and guides, especially if there is some mismatch in diameter between a small radial artery and a large bore catheter. Radial artery spasm can be prevented by administration of intraarterial spasmolytic cocktails [10]. However, in some instances these cocktails may result in hypotension and bradycardia. Patients with a significant aortic stenosis have a fixed stroke volume and therewith are at high risk of refractory and life threatening hypotension after administration of spasmolytic cocktail. In this case report, we describe a recently published technique [11] to overcome severe radial spasm in a patient with moderate to severe aortic valve stenosis who underwent TRA coronary angiography. 2. Case A 70-year-old male patient was referred for coronary angiography because of chest pain on exertion. In preceding years, he visited our outpatient department for echocardiographic follow-up of a moderate aortic valve stenosis. During the last visit he expressed typical anginal complaints while echocardiographic evaluation of the aortic valve displayed a stable function. Patient underwent coronary angiography via right radial access. After uneventful puncture and cannulation of a
Transradial angiography procedure approach in with and without radial artery anomalies  [PDF]
Saeed Yazdankhah, Ahmadreza Assareh, Shahla Majeedi, Mehdi Easapour, Mohammad Nourizadeh, Farzaneh Ahmadi, Farzad Daeinejad
Health (Health) , 2013, DOI: 10.4236/health.2013.56145
Abstract:

Introduction: The transradial coronary angiography has several benefits such as the reducetion in access site complications especially in fully anticoagulated patients. The presence of arterial anomalies in upper limb arteries has an important role in procedural success. Methods: retrograde transarterial sheath injection was done in patients with transradial coronary angiography. Arterial anomalies in the upper limb evaluated. Cannulation time, the time of catheter passage to ascending aorta, and Angiographic time, were also meseared. Results: in 2011, 165 consecutive patients were studied, 116 (70.3%) male, age 56.7 ± 11.1 years. With 96.6% success rate in procedure, totally 59 anomolies were observed in 44 patients (26.7%). Radial artery by itself had ?25 anomalies (15.1%). The most frequent anomaly was abnormal origin of radial artery in 14 patients (8.5%) followed by tortuosities in 10 ulnar (6%). 9 brachial (5.4%), 7 radial (4/2%), 5 subclavian (3%) and 3 brachiocephalic arteries (1.8%). There also were 4 loops in ulnar artery (2.4%) and one in radial and brachinl arteries (each 0.6%). Other anomalies include 4 patients (2.4%), except cannulation time (p = 0.97), there were associations between anomalies and each of other times (p = 0.001) and contrast volume (p = 0.009). Anomalies didn’t have any effect on procedural success rate and just in one patient with sulclavian loop procedure changed to femoral approach (p = 0.19).

Transradial approach for coronary interventions
Brito, José Carlos;Azevedo Júnior, Ant?nio;Oliveira, Adriano;Von Sohsten, Roberto;Santos Filho, Ademar;Carvalho, Heitor;
Arquivos Brasileiros de Cardiologia , 2001, DOI: 10.1590/S0066-782X2001000500003
Abstract: objective: to assess the feasibility and safety of coronary interventions performed through the radial artery. methods: we studied 103 patients with ages from 38 to 86 years (57±8.7), 90 (87%) males, and: radial pulse with a good amplitude, presence of ulnar pulse, a good collateral flow through the palmar arch assessed with the allen's test. results: the vascular approach was obtained in 97 (94%) patients, 88 (91%) treated electively and 9 (9%) during acute myocardial infarction, for primary angioplasty; 56 (64%) unstable angina; 22 (25%) stable angina; 10 (11%) were asymptomatic, 6 referred for recanalization of chronic occlusion and 4 silent ischemia in the first week after acute myocardial infarction. we approached 107 arteries: anterior descending artery, 49 (46%); right coronary artery, 27 (25%); circumflex artery, 25 (23%); diagonal artery, 6 (6%); and 2 saphenous vein bypass grafts. we treated 129 lesions: 80 (62%) b2 type; 23 (18%) b1 type; 17 (13%) c type; and 9 (7%). a type. there were 70 stents , and 59 balloon angioplasties performed. thirty-two (33%) patients used gp iib/iiia inhibitors. the mean duration of the elective procedure was 42.3±12.8 min. success, correct stent deployment and residual lesion <20%, was reached in 100% of the lesions treated with stent implantation; arterial dilation with residual lesion <50% was obtained in 96% of the lesions treated with transluminal coronary angioplasty (tca). complications, were: 1 (1.0%) non-q-wave acute myocardial infarction; 2 (2%) hematomas in the forearm; and 2 losses of radial pulse. conclusion: radial artery aproach is practical and safe for percutaneous coronary interventions there was a low incidence of complications.
Transradial approach for coronary interventions  [cached]
Brito José Carlos,Azevedo Júnior Ant?nio,Oliveira Adriano,Von Sohsten Roberto
Arquivos Brasileiros de Cardiologia , 2001,
Abstract: OBJECTIVE: To assess the feasibility and safety of coronary interventions performed through the radial artery. METHODS: We studied 103 patients with ages from 38 to 86 years (57±8.7), 90 (87%) males, and: radial pulse with a good amplitude, presence of ulnar pulse, a good collateral flow through the palmar arch assessed with the Allen's test. RESULTS: The vascular approach was obtained in 97 (94%) patients, 88 (91%) treated electively and 9 (9%) during acute myocardial infarction, for primary angioplasty; 56 (64%) unstable angina; 22 (25%) stable angina; 10 (11%) were asymptomatic, 6 referred for recanalization of chronic occlusion and 4 silent ischemia in the first week after acute myocardial infarction. We approached 107 arteries: anterior descending artery, 49 (46%); right coronary artery, 27 (25%); circumflex artery, 25 (23%); diagonal artery, 6 (6%); and 2 saphenous vein bypass grafts. We treated 129 lesions: 80 (62%) B2 type; 23 (18%) B1 type; 17 (13%) C type; and 9 (7%). A type. There were 70 stents , and 59 balloon angioplasties performed. Thirty-two (33%) patients used GP IIb/IIIa inhibitors. The mean duration of the elective procedure was 42.3±12.8 min. Success, correct stent deployment and residual lesion <20%, was reached in 100% of the lesions treated with stent implantation; arterial dilation with residual lesion <50% was obtained in 96% of the lesions treated with transluminal coronary angioplasty (TCA). Complications, were: 1 (1.0%) non-Q-wave acute myocardial infarction; 2 (2%) hematomas in the forearm; and 2 losses of radial pulse. CONCLUSION: Radial artery aproach is practical and safe for percutaneous coronary interventions there was a low incidence of complications.
Effectiveness of transradial access in percutaneous coronary interventionism.
Javier Almeida Gómez,Abel Yoandri Leyva Quert,Emil Andrés Moronta Soriano,Joel Brooks Tamayo
Revista Cubana de Cardiología y Cirugía Cardiovascular , 2011,
Abstract: Introduction Transradial approach for coronary interventional procedures is becoming moreattractive mainly for shortening hospitalization and dramatically reduces access-site complications. At present, the transradial approach has become theprimary vascular access for revascularization at the Hermanos Ameijeiras′scatheterization laboratory.Objective To determine the effectiveness of the transradial approach and the short termsurvival free of major cardiac eventsMethod An observational prospective study was done in 279 patients who underwentpercutaneous coronary interventions from September 2009 to May 2010. Themajor cardiac events included were death, non fatal myocardial infarction, urgentvessel revascularization and major bleeding. The survival rates were estimatedby the Kaplan Meier method and compared by means of the Log Ranktest.Results Radial access was used in 68, 46 % cases and the success rate was similar tothe transfemoral approach (93.2% vs. 89.8%, p=0.325), there was no differenceregarding the treated lesions, deployed stents, procedure and fluoroscopytimes. There were less major cardiac events when the TRA was used (2.1% vs6.8%, p=0.049). The numbers of patients free from major cardiac events at 30days were 97.9% and 93.18% for radial and femoral approaches respectively.Conclusions In summary, the TRA is safe and effective during PCI with short term survivalfree of major cardiac events that has surpassed the transfemoral approach.
Safety and feasibility of transradial coronary intervention in Chinese elderly patients
Quanmin JING,Yaling HAN,Shouli WANG,Yingyan MA,Bo LUAN,Huiquan ZHAO,
Quanmin JING
,Yaling RAN,Shouli WANG,Yingyan MA,Bo LUAN,Huiquan ZHAO

老年心脏病学杂志(英文版) , 2007,
Abstract: Objective To assess the feasibility and safety of transradial approach in Chinese elderly patients undergoing coronary intervention. Methods In this prospective study, 764 elderly patients with coronary artery disease received percutaneous coronary intervention via either a transradial approach (TRA group) or a transfemoral approach (TFA group). The procedural success rate, success rate of artery access, puncture time, fluoroscopy time, dose of contrast, local complications and post-procedural pulmonary embolism were recorded and compared between 2 groups. Results There was no significant difference of the procedural success rate between the TRA group and the TRF group (96.3% vs. 98.2%, P>0.05); there were also no differences of success rate of cannulation, mean fluoroscopy time and mean dose of contrast between the 2 groups. The mean puncture time was longer in the TRA group than in the TFA group (3.8±2.1 min vs. 2.0±3.4 min, P<0.05). However, there were fewer access site-related complications in the TRA group than in the TFA group. Post-procedural pulmonary embolism occurred in 2 patients in the TFA group but none in the TRA group. Conclusion Transradial coronary intervention was feasible and safe in most Chinese elderly patients when performed by experienced operators.
Left Radial Approach versus Right Radial Approach of Coronary Angiography in the Diagnosis of Coronary Heart Disease  [PDF]
Pasupati Rajoria, Chenghong Xu, Yunfeng Zhang, Wenjun Guan, Hua Yang, Keping Yang
World Journal of Cardiovascular Diseases (WJCD) , 2016, DOI: 10.4236/wjcd.2016.68030
Abstract: Background: Transradial coronary angiography has established itself as safe alternative to transfemoral approach. Today, the artery of approach lies completely on the operator’s choice. The Right Radial Approach (RRA) has been a favorite for most of the interventional cardiologists due to the convenience in operating from the right side. The Left Radial Approach (LRA) has always been a neglected route. LRA does have many advantages over the right, the vascular anatomy being one of them. The aim of our study was to compare the right radial approach of diagnostic coronary angiography with left radial approach. Method: A total of 70 cases of Coronary Angiography (CAG) with normal Allen test and satisfying the inclusion criteria were prospectively observed and studied after randomly assigning them into two equal groups, LRA (Left Radial Approach) n = 35 and RRA (Right Radial Approach) n = 35. Multipurpose TIG (Tiger) catheter was used in both the approaches to catheterize the right as well as left coronary artery. Results: The access time, catheter manipulation time, procedure time, amount of contrast used, hospital stay, intensity of pain experienced, cost of the procedure and quality of coronary angiogram observed were statistically insignificant while the fluoroscopy time was slightly statistically significant which was independent to catheter manipulation time. Conclusions: The neglected Left Radial Approach to coronary angiography is as efficacious, safe and cost effective with reduction in arterial spasm complications when compared to the Right Radial Approach performed by multipurpose Tiger catheter.
A Randomized, Single-Center Double-Blinded Trial on the Effects of Diltiazem Sustained-Release Capsules in Patients with Coronary Slow Flow Phenomenon at 6-Month Follow-Up  [PDF]
Lun Li, Ye Gu, Tao Liu, Yupeng Bai, Lingbo Hou, Zhong Cheng, Liqun Hu, Bo Gao
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0038851
Abstract: Objective The aim of this study is to observe the chronic effects of diltiazem release capsules on patients with coronary slow flow (CSF) phenomenon. Methods From 2004 to 2009, 80 consecutive patients with chest pain and normal coronary arteries evidenced by coronary angiography and CSF were included in this randomized, double-blind, placebo-controlled trial. CSF patterns were evaluated by the corrected TIMI frame count. Patients were randomly assigned at 1:1 ratio to diltiazem sustained-release capsules treatment group (Dil, 90 mg twice daily) or placebo control group. Holter, liver and kidney function, treadmill exercise test, coronary angiography and left ventricular angiography were measured at baseline and after 6 months. The incidence of cardiovascular events (re-admission or progress in coronary heart disease, myocardial infarction, malignant arrhythmia or cardiac death) was evaluated during the 6 months follow up. Results Thirty-nine patients in control and 40 patients in Dil group completed the 6 months follow-up. There was no medication induced drug withdraw during follow up. Left ventricular ejection fraction was similar between the 2 groups at baseline and during follow up. Heart rate was significantly lower in Dil group than in control group and there was no symptomatic bradycardia and II and III degree atrioventricular conduction block in both groups. Significant improvement was observed in the onset of chest pain, treadmill exercise test and coronary blood flow in Dil group while these parameters remained unchanged in control group at the end of 6 months follow up. The incidence of cardiovascular events was similar between the two groups. Conclusion Diltiazem slow-release capsules improved coronary blood flow and alleviated angina in patients with CSF. Trial Registration Chinese Clinical Trial Registry ChiCTR-TCC-11001864
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